Apparatus and methods for percutaneous cochlear implantation

Abstract

A method and apparatus of percutaneous cochlear implantation (PCI). In one embodiment, the method includes the steps of (a) implanting a plurality of anchor members in a skull of a patient surrounding an ear of the patient, (b) attaching a docking frame to the plurality of anchor members, wherein the docking frame has a docking platform and a plurality of fiducial members, (c) acquiring a computed-tomography (CT) image of an area of the patient's head including the ear and the plurality of fiducial members, (d) determining a centroid of each of the plurality of fiducial members and a trajectory for a PCI according to the CT image, (e) configuring a parallel robot by a computer processor according to the CT image such that a top platform of the parallel robot is aligned with the trajectory with respect to the centroids of the plurality of fiducial members, (f) attaching the configured parallel robot to the docking frame, and (g) performing the PCI using one or more surgical tools received by the top platform of the parallel robot.

What is claimed is: 
     
       1. A method of percutaneous cochlear implantation (PCI), comprising the steps of:
 (a) implanting a plurality of anchor members in a skull of a patient surrounding an ear of the patient; 
 (b) attaching a prepositioning frame to the plurality of anchor members, the prepositioning frame comprising (i) a prepositioning platform with a central through hole adapted for allowing physical access to the ear during a PCI, and (ii) a plurality of fiducial members protruding from a top surface of the prepositioning platform; 
 (c) acquiring a computed-tomography (CT) image of an area of the patient's head including the ear and the plurality of fiducial members; 
 (d) determining a centroid of each of the plurality of fiducial members and a trajectory for the PCI according to the CT image; 
 (e) configuring a parallel robot by a computer processor according to the CT image, wherein the parallel robot comprises a top platform and a base platform connected via a plurality of linear actuators, the top platform adapted for receiving one or more surgical tools, the base platform having a plurality of receiving mechanisms, each receiving mechanism adapted for receiving a respective fiducial member, each of the top platform and the base platform defining a central through hole adapted for allowing the one or more surgical tools to pass therethrough during the PCI, and wherein the computer processor is programmed to set each of the plurality of linear actuators such that the top platform is aligned with the trajectory with respect to the centroids of the plurality of fiducial members to be received by the plurality of receiving mechanisms; 
 (f) attaching the parallel robot to the prepositioning frame such that each of the plurality of fiducial members is received by a respective receiving mechanism in the base platform of the parallel robot; and 
 (g) performing the PCI using the one or more surgical tools received by the top platform of the parallel robot, 
 wherein the prepositioning frame is designed using prior clinical data and the parallel robot is configured according to the CT image such that when the parallel robot is attached to the prepositioning frame, a nominal position of the parallel robot is aligned with an optimal trajectory for the PCI. 
 
     
     
       2. The method of  claim 1 , wherein the plurality of anchor members comprises three anchor members. 
     
     
       3. The method of  claim 1 , wherein the plurality of fiducial members comprises three fiducial members. 
     
     
       4. The method of  claim 1 , wherein each of the plurality of fiducial members has at least a partial spherical shape. 
     
     
       5. The method of  claim 1 , wherein each of the plurality of fiducial members is made of titanium. 
     
     
       6. The method of  claim 1 , wherein the prepositioning platform is made of aluminum or carbon fiber. 
     
     
       7. The method of  claim 1 , wherein the plurality of linear actuators comprises six linear actuators mounted in pairs to the base platform of the parallel robot and crossing over to three mounting points on the top platform of the parallel robot. 
     
     
       8. The method of  claim 1 , wherein the parallel robot is adapted for affording six degrees of freedom when the parallel robot is being configured. 
     
     
       9. The method of  claim 1 , wherein the parallel robot is adapted for affording four degrees of freedom when the parallel robot is being configured. 
     
     
       10. The method of  claim 1 , wherein the parallel robot is adapted such that the top platform of the parallel robot can be aligned with the trajectory with a precision better than about 0.9 mm. 
     
     
       11. An apparatus for percutaneous cochlear implantation (PCI), comprising:
 (a) a prepositioning frame adapted for being attachable to a plurality of anchor members implanted in a skull of a patient surrounding an ear of the patient, the prepositioning frame comprising a prepositioning platform and a plurality of fiducial members protruding from a top surface of the prepositioning platform, the prepositioning platform defining a central through hole adapted for allowing physical access to the ear when the prepositioning frame is attached to the plurality of anchor members for a PCI; and 
 (b) a parallel robot attached to the prepositioning frame, the parallel robot comprising a top platform and a base platform connected via a plurality of linear actuators, the top platform adapted for receiving one or more surgical tools, the base platform having a plurality of receiving mechanisms, each receiving mechanism adapted for receiving a respective fiducial member of the prepositioning frame, each of the top platform and the base platform defining a central through hole adapted for allowing the one or more surgical tools to pass therethrough during the PCI;
 wherein the parallel robot is configurable by a computer processor according to a computed tomography (CT) image acquired when the prepositioning frame is attached to the plurality of anchor members implanted in the skull of the patient, the CT image comprising an image of an area of the patient's head including the ear and the plurality of fiducial members, and wherein the computer processor is programmed to (i) determine a centroid of each of the plurality of fiducial members and a trajectory for the PCI according to the CT image, and (ii) set each of the plurality of linear actuators of the parallel robot such that the top platform of the parallel robot is aligned with the trajectory with respect to the centroids of the plurality of fiducial members; and 
 wherein the prepositioning frame is designed using prior clinical data and the parallel robot is configured according to the CT image such that when the parallel robot is attached to the prepositioning frame, a nominal position of the parallel robot is aligned with an optimal trajectory for the PCI. 
 
 
     
     
       12. The apparatus of  claim 11 , wherein the plurality of anchor members comprises three anchor members. 
     
     
       13. The apparatus of  claim 11 , wherein the plurality of fiducial members comprises three fiducial members. 
     
     
       14. The apparatus of  claim 11 , wherein each of the plurality of fiducial members has at least a partial spherical shape. 
     
     
       15. The apparatus of  claim 11 , wherein each of the plurality of fiducial members is made of titanium. 
     
     
       16. The apparatus of  claim 11 , wherein the prepositioning platform is made of aluminum or carbon fiber. 
     
     
       17. The apparatus of  claim 11 , wherein the plurality of linear actuators comprises six linear actuators mounted in pairs to the base platform of the parallel robot and crossing over to three mounting points on the top platform of the parallel robot. 
     
     
       18. A method of performing an intracranial surgery, comprising the steps of:
 (a) implanting three or more anchor members in a skull of a patient; 
 (b) attaching a prepositioning frame to the three or more anchor members, the prepositioning frame comprising (i) a prepositioning platform with a central through hole adapted for allowing physical access to an area of the patient's brain under surgery, and (ii) three or more fiducial members protruding from a top surface of the prepositioning platform; 
 (c) acquiring a computed-tomography (CT) image of the area of the patient's brain including the three or more fiducial members; 
 (d) determining a centroid of each of the three or more fiducial members and a trajectory for the intracranial surgery according to the CT image; 
 (e) configuring a parallel robot by a computer processor according to the CT image, wherein the parallel robot comprises a top platform and a base platform connected via a plurality of linear actuators, the top platform adapted for receiving one or more surgical tools, the base platform having a plurality of receiving mechanisms, each receiving mechanism adapted for receiving a respective fiducial member, each of the top platform and the base platform defining a central through hole adapted for allowing the one or more surgical tools to pass therethrough during the intracranial surgery, and wherein the computer processor is programmed to set each of the plurality of linear actuators such that the top platform is aligned with the trajectory with respect to the centroids of the three or more fiducial members to be received by the plurality of receiving mechanisms; 
 (f) attaching the parallel robot to the prepositioning frame such that each of the three or more fiducial members is received by a respective receiving mechanism in the base platform of the parallel robot; and 
 (g) performing the intracranial surgery using the one or more surgical tools received by the top platform of the parallel robot, 
 wherein the prepositioning frame is designed using prior clinical data and the parallel robot is configured according to the CT image such that when the parallel robot is attached to the prepositioning frame, a nominal position of the parallel robot is aligned with an optimal trajectory for the intracranial surgery. 
 
     
     
       19. The method of  claim 18 , wherein each of the three or more fiducial members has at least a partial spherical shape. 
     
     
       20. The method of  claim 18 , wherein each of the three or more fiducial members is made of titanium. 
     
     
       21. The method of  claim 18 , wherein the prepositioning platform is made of aluminum or carbon fiber. 
     
     
       22. The method of  claim 18 , wherein the plurality of linear actuators comprises six linear actuators mounted in pairs to the base platform of the parallel robot and crossing over to three mounting points on the top platform of the parallel robot.